【摘要】 目的：描述血浆醛固酮浓度（plasma aldosterone concentration,PAC）与醛固酮肾素活性比值（aldosterone to renin ratio,ARR）的个体内变异，调查基于现行指南和专家共识推荐的PAC和ARR切点的原发性醛固酮增多症（primary aldosteronism,PA）筛查阳性率现状。方法：从2017年4月—2021年3月南京医科大学第一附属医院内分泌科确诊的PA患者中选取具有在不同日期2～4次PAC和ARR检测结果者80例，分析每个研究对象PAC和ARR的个体内变异系数（coefficient of variation,CV）和百分比差异。使用指南推荐阈值：PAC <10、15、20 ng/dL;ARR <20、25、30(ng/dL)/[ng/（mL·h）]，分别量化低于阈值的单次、平均PAC以及ARR的PA患者占总人数的百分比。结果：80例研究对象共有182次立位血浆肾素活性（plasma rennin activity,PRA）和PAC测量结果。PAC和ARR的CV为19.74%和26.11%；百分比差异为41.78%和52.22%。35.0%、75.0%、93.7%的研究对象至少有1次PAC分别低于10、15、20 ng/dL;10.0%、37.5%、72.6%的研究对象至少有2次PAC分别低于10、15、20 ng/dL。17.5%、26.3%、36.3%的研究对象至少有1次ARR分别低于20、25、30(ng/dL)/[ng/（m L·h）];5.0%、6.3%、6.3%的研究对象至少有2次ARR分别低于20、25、30(ng/dL)/[ng/（mL·h）]。结论：PA的PAC和ARR因多重因素影响，个体内变异大，单次筛查值低于指南推荐阳性切点比例高，易致PA筛查假阴性率高。对疑似PA患者多次筛查及通过重新校准PA筛查的方法和切点，纳入更宽松的PAC和ARR筛查阈值，有助于显著提高PA的诊断率。更多还原

【Abstract】 Objective:To describe the intra-individual variation of plasma aldosterone concentration(PAC)and aldosterone to renin ratio(ARR),and to investigate the current situation where positive rate of primary aldosteronism(PA)is based on cut-off values guideline recommended. Methods:Eighty PA patients diagnosed in the Department of Endocrinology,the First Affiliated Hospital of Nanjing Medical University from April 2017 to March 2021 who have 2～4 separated PAC and ARR results on different date were enrolled to calculate the intra-individual coefficient of variation(CV)and percentage difference of PAC and ARR. The percentage of PA patients with single average PAC and ARR below the recommended{PAC<10,15,20 ng/dL;ARR<20,25,30(ng/dL)/[ng/（mL·h）]}were analyzed. Results:Totally 182 plasma rennin activity(PRA)and PAC measurements from 80 subjects were collected. CV of PAC and ARR was 19.74% and 26.11% respectively,the percentage difference was 41.78% and 52.22%. 35.0%,75.0%,93.7% subjects had at least one measurement of PAC lower than 10,15,20 ng/dL respectively;10.0%,37.5% and 72.6% subjects had at least twice PAC lower than 10,15,20 ng/dL respectively. 17.5%,26.3%,36.3% subjects had at least one ARR lower than 20,25,30(ng/dL)/[ng/（mL·h）]respectively;5.0%,6.3%,6.3% subjects had at least twice ARR lower than 20,25,30(ng/dL)/[ng/（mL · h）] respectively.Conclusion:The PAC and ARR in PA vary greatly in individuals on account of multiple factors. The proportion of single screening values below the positive cut-off values guideline recommended is relatively high,which may lead to false negative rate of PA screening. For suspected patients,screening repeatedly,recalibrating PA screening cut-off point and bringing wider PAC and ARR screening thresholds can improve PA diagnosis rates significantly.更多还原